Individual
SAMANTHA LEAHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3023 HAMAKER CT STE 500, FAIRFAX, VA 22031-2241
(703) 876-2788
Mailing address
4113 DUNCAN DR, ANNANDALE, VA 22003-3704
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110005629
VA
363AS0400X
Surgical Physician Assistant
Primary
0110005629
VA
Other
Enumeration date
01/05/2017
Last updated
02/27/2020
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